Hydronephrosis, a systemic condition that causes the kidneys to become enlarged, affects many people worldwide. This common kidney problem occurs when urine can't drain properly from the kidneys, leading to fluid buildup. Understanding hydronephrosis is crucial because it can cause discomfort and, if left unattended, may lead to serious kidney damage. In this blog, we'll explore the ins and outs of one of the common kidney problems, hydronephrosis.
What is Hydronephrosis?
Hydronephrosis is a condition that affects one or both kidneys, causing them to swell up due to a buildup of urine. This condition happens when urine can't drain properly from the kidneys to the bladder. It's like having a blocked pipe in your plumbing system, but instead of water, it's urine that's backing up. Symptoms can be sudden or chronic, partial or complete. Unilateral hydronephrosis refers to the condition where only one kidney is affected, and bilateral hydronephrosis refers to the condition in which both kidneys are affected.
Symptoms of Hydronephrosis
Hydronephrosis often doesn't cause noticeable symptoms, especially in its early stages. However, as the condition progresses, various signs may appear.
In infants with congenital hydroureteronephrosis, symptoms are typically absent. However, severe cases might lead to:
Bilateral hydronephrosis poses an even greater risk, involving the enlargement of the parts of the kidneys that collect urine on both sides.
For pregnant women, hydronephrosis can present unique challenges. The condition may result in pain in the lower abdomen or back, frequent urination, and an increased risk of UTIs.
Hydronephrosis Diagnosis
The diagnostic process involves:
Medical History Review and Physical Examination: The doctors will ask about any symptoms and examine the area surrounding the kidneys and bladder for tenderness or swelling. They may also inquire about the patient's and their family's medical history. For male patients, a rectal exam might be necessary to check for an enlarged prostate. Those with a vagina might need a pelvic exam to evaluate any issues with the uterus or ovaries.
Urine Analysis: Urine tests to check blood, stone crystals, bacteria, or signs of infection.
Blood Picture: Blood analysis includes a complete blood count (CBC) to check for infection and tests of kidney function such as creatinine, estimated GFR (eGFR), and blood urea nitrogen (BUN).
Advanced Imaging:
Imaging procedures such as ultrasound, CT scan, or MRI
A voiding cystourethrogram is recommended for infants with congenital hydroureteronephrosis to identify patients with vesicoureteral reflux.
In cases where the obstruction is suspected, doctors may perform a nuclear medicine diuretic renogram to assess urine flow and differentiate it from other causes, such as an extra-renal pelvis or parapelvic cysts.
Treatment
For mild hydronephrosis treatment, doctors may recommend a "wait and see" approach, as some instances resolve over time without intervention. However, active hydronephrosis treatment is necessary for more severe cases or those causing complications. Treatment includes:
Draining Excess Urine:
To provide immediate relief and prevent further hydronephrosis kidney damage, doctors often start by draining the excess urine through:
Urinary catheterization
Nephrostomy tube
A ureteral stent to hold the ureters open, allowing urine to flow normally.
Treating Underlying Causes: Once the immediate pressure is relieved, treatment focuses on addressing the root cause:
Kidney Stones: If stones are causing the obstruction, treatment options include:
Shock wave lithotripsy
Ureteroscopy
Surgery for very large or difficult-to-remove stones
Infections: Doctors may prescribe antibiotics if a urinary tract infection (UTI) is present or the urinary tract is narrowed due to infection.
Tumours or Other Blockages: Surgery may be necessary to remove tumours, scar tissue, or other obstructions.
During pregnancy, treatment typically involves:
Regular catheterization to drain urine
Pain management
Antibiotics if a UTI develops
Long-term Management: For some patients, ongoing management may be necessary:
Follow-up imaging studies to assess kidney function and hydronephrosis status
Monitoring for improvement or worsening of the condition
Regular replacement of ureteral stents
When to See a Doctor
People should contact their doctor if they experience any of the following hydronephrosis symptoms:
Preventing hydronephrosis depends on avoiding or promptly treating its underlying causes. These include:
Drink plenty of water to maintain a minimum of 2000 mL urine output daily
Limit salt intake
Moderate animal protein intake
Balance calcium intake
Maintain good hygiene
Urinate regularly and after sexual activity
Regular prostate check-ups
Limit high-oxalate foods
Conclusion
Hydronephrosis is a serious kidney condition that has an impact on the quality of life. Its causes range from kidney stones to pregnancy-related issues, and it can lead to complications if left untreated. Early detection and proper treatment plan are crucial to prevent long-term kidney damage. By understanding the symptoms and risk factors, people can take proactive steps and improve their kidney health.
FAQ's
1. How common is hydronephrosis?
Hydronephrosis is a relatively common condition. It can affect people of all ages, with a male-to-female ratio of 2:1.
2. Does drinking water help hydronephrosis?
While drinking water doesn't directly cure hydronephrosis, maintaining adequate fluid intake is crucial for overall kidney health. Increased fluid intake can help:
Prevent stone formation
Reduce the risk of urinary tract infections
Promote urine flow
3. What should you avoid if you have hydronephrosis?
If you have hydronephrosis, avoiding factors that could worsen the condition or increase the possibility of complications is essential. Here are some key points:
Limit salt intake
Moderate animal protein intake
Balance calcium intake
Avoid high-oxalate foods
Limit phosphorus and potassium
Reduce processed foods
Avoid holding urine for long periods
4. What is the leading cause of hydronephrosis?
The leading cause of hydronephrosis is a blockage or obstruction in the urinary tract that prevents urine from flowing normally from the kidneys to the bladder.
5. Can you recover fully from hydronephrosis?
The potential for complete recovery from hydronephrosis depends on several factors, including the underlying reason, the severity of the condition, and how quickly it's treated.
6. Can hydronephrosis be cured?
Hydronephrosis is often treatable; in many cases, it can be effectively managed or cured. The treatment approach depends on the underlying ailment and the severity of the condition.